(226) Hearing Loss in Urban vs. Rural Dominican Republic Communities

Introduction: The Dominican Republic, like many low and middle income countries, have no standardized, nationwide pediatric hearing screening. The aim of this study was to report on a pediatric hearing screening program developed with a local NGO in the Dominican Republic, measure otologic health in school-age children and quantify disparities in hearing loss in children who live in the capital Santo Domingo versus surrounding rural communities.

Methods: A hearing screening was performed on 243 children between the ages of 3 to 17 years old at a K-12 school in Santo Domingo. The screening included otoscopy, tympanometry, audiometry, and an otoacoustic emissions (OAE) test. Audiometry was used to confirm screening thresholds at 25dB at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Tympanometry recorded normal, negative, or flat pressure. Results were compared with ongoing hearing screening missions in Villa Verde, a rural community.

Results: Of 243 patients screened in Santo Domingo, 41 children (16.9%) presented with abnormal otoscopic results. This included impacted cerumen, tympanic perforations, otitis media, and ear canal foreign objects. Tympanometric testing revealed 7 children (2.9%) with abnormal results, 2 children (0.8%) who did not tolerate OAEs, and 3 children (1.2%) who failed audiometric screening. In Villa Verde, 4.7% of 85 children screened presented with abnormal otoscopy, 16.4% with abnormal tympanometry, 5.3% did not tolerate OAEs, and 5.7% failed audiometric screening. Based on chi-square analysis, all comparative tests were statistically significant (p < 0.05).

Conclusions: The prevalence of hearing loss and abnormal otologic presentations was higher in children in the rural Villa Verde site compared to the urban site in Santo Domingo. At the rural site, 5.7% of children failed audiometric screening compared to 1.2% in the urban site. Expansion of the hearing screening program, especially to more rural communities, will better clarify regional disparities in hearing loss in school-age children in the Dominican Republic. Further studies should focus on identifying factors that contribute to these differences.